“There's no Medicaid for them”: Barriers to accessing public funding for low-income women seeking abortions in cases of rape, incest, and life endangerment

Background: Low-income women's access to reproductive health care in the US is hampered by healthcare providers' difficulties navigating the Medicaid system and state and federal restrictions on funding for abortion. Anecdotal and regional data show that providers are unable to access funding even when women are legally eligible.

Purpose: To document abortion providers' experiences seeking Medicaid funding in qualifying cases and analyze barriers to and facilitators of funding success.

Methods: We conducted over sixty semi-structured in-depth telephone interviews with abortion providers from October 2007-February 2010. Interviews were recorded and transcribed verbatim. We conducted a thematic analysis of the interviews using Atlas.ti.

Results: Almost all providers reported “giving up” on Medicaid due to difficulties navigating the reimbursement process. Providers reported that attempts to obtain funding were “futile” and that Medicaid frequently rejects qualifying claims. The proliferation of HMO's under Medicaid appears to have increased confusion about the procedures for accessing funding for abortion, as have changes in regulations about the circumstances under which Medicaid covers abortions. Providers reported that low-income women were forced to take drastic measures to pay for their procedures, often delaying the abortion and sometimes forcing a woman to continue an unwanted pregnancy.

Providers working in only two states reported consistently obtaining reimbursements for abortion care, and providers in one additional state reported moderate though inconsistent success. Even where procedures were reimbursed, reimbursement rates were extremely low.

Conclusion: Bureaucratic Medicaid policies and procedures unjustly deny access to Medicaid funding for abortion care for low-income women.